There are several different reasons for a patient seek medical advice because of abdominal pain. Do doctors remember them all? Probably not, and that is why not only a constant update is necessary but also review readings are paramount. In that setting Dr. Teresa Caroço et al. published this year a paper about one rare and frequently forgotten pathology, the mesenteric cyst.
Mesenteric cyst can be malignant and complications can occur.
One male patient resorted to general surgery consultation of CHUC-HG (Covões), Coimbra, Portugal, complaining of episodic abdominal pain. On physical examination the Tillaux’s sign was present (if you do not remember this, read the article). An ultrasonography and an abdominal CT scan pointed out for a 9cm mesenteric cyst of the small bowel mesentery. What treatment should be offered? Remember imaging findings do not have 100% accuracy. Although usually benign, the mesenteric cyst may represent a malignant disease. Additionally, complications such as bowel obstruction, peritonitis (hemorrhage, infection) and volvulus can occur. Surgical excision is the treatment of choice, and was the treatment offered to this patient. A lymphangioma was the final diagnosis.
Surgeons must remember this unusual entity and be aware that despite being usually benign, a mesenteric cyst (in this case a lymphangioma) is an indication for surgery since malignancy cannot be accurately excluded with a biopsy.
Surgery is the treatment of choice.
For more information about etiology, presentation and diagnosis of this entity, feel free to read the article (open access). Knowledge is never too much. Study it in the present so you can recognize it in the future.
Link to article:
Dr. Carlos Eduardo Costa Almeida
General Surgeon
Good evening Dr. Carlos. One should not forget those patients who have benign diseases that behave aggressively like abdominal desmoid tumors (like you already have published earlier). Theses patients may/should be treated in a non surgical manner depending on its location like main vascular irrigation (ie. small bowel mesentery), and remembering its high relapse behaviour. Sulindac has been proved as a good treatment. But, as you state, surgical procedure with excisional biopsy is the treatment of choice when a cyst is clinical relevant and because of its potential malignancy.
Keep up the good work.
João Louro